Why focus on uric acid?

In gouty patients, urate lowering therapies (ULTs) are recommended to bring serum uric acid (SUA) levels below 6.0 mg/dL, with the aim of dissolving urate depositions, thereby reducing disease impact. However, patients with hyperuricemia often present with other conditions associated with cardiovascular (CV) risk, such as high blood pressure, obesity, insulin resistance, fatty liver, and chronic kidney disease. In the last decade, several well grounded pieces of evidence showed that the elevation of uric acid often occurs prior to the development of hypertension or metabolic syndrome, thus suggesting a direct association between elevated SUA and these conditions. This paper will discuss available evidence supporting the key role of serum uric acid in the development of CV and renal disease, with a focus on the molecular mechanisms underlying this causative association. This review is based on a PubMed/Embase database search for articles on hyperuricemia and its impact on cardiovascular and renal function.